View full sizeJohn Kuntz, The Plain DealerMetroHealth Medical Center, handles the Level 1 traumas in the Cleveland area. In this December 2011 photo, Dr. Sara Laskey, works with emergency doctors and technicians to get vital signs and diagnosis of a patient who was rushed in after an automobile accident.

CLEVELAND, Ohio -- Standardizing treatment and transportation protocols has resulted in significant improvements in health outcomes for trauma patients in Northeast Ohio, according to a new study.

The report, released at 1 p.m. today, analyzes the outcomes of nearly 30,000 patients who have been treated at area trauma centers since 2008. It shows fewer deaths since 2010, when a regional trauma system was formed.

Among the study's key findings, which compared outcomes in the two years before and after the establishment of NOTS:

• The mortality rate for traumas in Cleveland dropped from 5.7 percent to 2.7 percent.

• The mortality rate for traumas on Cleveland's East side dropped from 5.3 percent to 3.2. percent.

• The mortality rate for patients in Cuyahoga County and surrounding counties dropped from 4.4 percent to 2.7 percent.

• The mortality rate for patients with penetrating injuries (such as gunshot and stabbing wounds) dropped from 10.1 percent to 6.5 percent.

The study was conducted using the two hospital systems' trauma patient registries, which the researchers merged into a single database.

Joel Downey, The Plain Dealer

The hospital systems released key findings, but not the full study, which is in the process of being submitted for publication, said Dr. Brendan Patterson, chairman of NOTS and executive director of the Surgery Patient Care Unit at MetroHealth.

Mortality rates for trauma patients have been on the decline across the country, said Dr. Nick Jouriles, former president of the American College of Emergency Physicians who is chairman of emergency medicine at Akron General Hospital.

A recent study looking at the outcomes of adult trauma patients in Pennsylvania is but one example of the national trend. The 10-year study, published in the August issue of the journal Archives of Surgery, showed a 30 percent drop in mortality rates.

Without seeing the raw data from the NOTS study, it's impossible to know whether the improvements locally are because of NOTS or if they're simply a reflection of a larger trend, Jouriles said.

Regionalization leads to trauma centers becoming better at what they do, he said.

"The bottom line -- if the data is correct and they're doing better, then they're saving money and lives," he said.

Cleveland EMS officials say the study doesn't address the unresolved issue of longer response times, something that has been a concern of theirs since the loss in 2011 of the Level 2 trauma center at Huron Hospital in East Cleveland.

"That issue is still very, very real," Cleveland Assistant Safety Director Ed Eckert said Monday. The study, he said, does not provide any relief to EMS when it comes to getting patients -- non-trauma patients and those with less severe traumatic injury -- to the hospital in a timely fashion.

NOTS has made it possible to get the right patients to the right hospital, and it has improved the care when they get there, said Dr. David Bronson, president of Cleveland Clinic Regional Hospitals.

And the positive results were apparent well before the two-year post-NOTS study period ended in 2011, said NOTS Medical Director Dr. Jeffrey Claridge, who conducted the study.

Claridge said he thought it would take a decade before seeing a significant effect on the mortality rate.

"The fact that we're seeing it already is incredibly surprising," he said.

MetroHealth, on the city's near West Side, has had the area's lone Level 1, adult trauma center since the centers at St. Luke's Medical Center and Mt. Sinai Medical Center, both on Cleveland's East Side, shut down in 1999 and 2000, respectively. Both hospitals have since closed.

Roughly half of all trauma cases are now transported to MetroHealth, which takes care of more than 80 percent of the most severely injured or ill patients. Hillcrest Hospital in Mayfield Heights, and Fairview Hospital, on Cleveland's West Side, operate the area's only Level 2 adult trauma centers.

Lakewood Hospital and the now-closed Huron Hospital in East Cleveland also were Level 2 adult trauma sites before the Clinic closed those two centers. Cleveland EMS stopped sending the most serious trauma patients to Huron shortly after the Clinic announced in October 2010 the plans to close the trauma center there.

NOTS was formed to develop a more efficient model for trauma care, Patterson said. "We've been able to improve the delivery and the outcomes, improve the public health of the Greater Cleveland community."

"[Cleveland cityofficials were] very concerned about what happened in some of the neighborhoods across greater Cleveland," Patterson said. "We specifically drilled down into some of those neighborhoods so that we could respond to the questions raised by [Mayor Frank Jackson]."

Before NOTS, "some of these patients got transferred twice, which was extremely detrimental," Patterson said.

The study does not specifically look at how patient mortality was impacted after the closing of Huron's trauma services. But, said Patterson, "We're pretty confident that the data for the East Side reflects the improvement in mortality for patients who would otherwise have gone to Huron Hospital."

Eckert, one of nine members of the NOTS board, said the study doesn't address what he calls a gap that has been created in areas of Cleveland -- the 99 percent of the EMS runs on the city's East Side, he said for which "Hillcrest is not an option."

Once the city goes through with its plan to hire 55 new emergency medical technicians and add three ambulances, the added resources will help fill the gap, Eckert said. However, he said, neither that, nor the NOTS study, plugs the gap completely.

Follow Us

cleveland.com is powered by Plain Dealer Publishing Co. and Northeast Ohio Media Group. All rights reserved (About Us).The material on this site may not be reproduced, distributed, transmitted, cached or otherwise used, except with the prior written permission of Northeast Ohio Media Group LLC.